Narrative mobile video game-based cognitive training to enhance frontal function in patients with mild cognitive impairment

Abstract

Although cognitive training has been proposed as a possible therapeutic modality for mild cognitive impairment (MCI), most serious games focus on specific tasks. This study aimed to investigate the feasibility and efficacy of narrative video game-based cognitive intervention for MCI. A four-week (± 1-week) mobile game intervention was given to 17 MCI participants (mean age (SD) = 72.8(4.75)). At baseline and post-intervention, the participants received neuropsychological tests and a depression scale. Frontal function was assessed using the Corsi block-tapping test, Color Word Stroop Test, Controlled Oral Word Association Test, Digit Symbol Coding, and Trail Making Test-Elderly's Version; depression was assessed using the Geriatric Depression Scale. User's compliance and gaming experience were also evaluated. MCI patients showed significant improvements in frontal function, particularly in Digit Symbol Coding (mean ± SD, 0.47 ± 0.49, p = 0.007) and phonemic fluency (mean ± SD, 0.39 ± 0.55, p = 0.024). Each frontal subtest's mean z-score was increased (mean ± SD, 0.44 ± 0.38, p = 0.008). Block span and depression scale remained unchanged. High adherence rates (122.35%) and favorable feedback on the gaming experience indicated that the game intervention's usability boosted patients' motivation and engagement. Our findings demonstrate that narrative game-based cognitive intervention was not only beneficial but also enjoyable for elderly MCI.

Fig. 1

An overview of the adherence of all participants. When participants completed the intervention five times per week for 4 weeks (± 1 week), the compliance rate was recorded as 100%. The possible highest rate was 140%, if the participant played seven times per week.

Fig. 2

(a) Game interface usability of the intervention. Participants evaluated whether the game interface was easy to use or not. (b) User experience of game storytelling of the intervention. (c) Impression of the background music of the intervention. (d) Mood changes after completing a session of the intervention.

Fig. 3

In-game display of the intervention. Participants should control the character to interact with various objects in game through the touch interface. Objects that the user should touch are gleaming and are related to the narrative of the game intervention. Key scene snapshots from the game narrative: Crash Landing (A), Into the Forest (B), Unlocking the Sealed House (C), Discovery of the Compass and Map (D).

Fig. 4

Storyline with tasks of the intervention. The red text in the figure corresponds to the sequence of the game’s storyline, following the numbered order. Each box contains the tasks being trained at the corresponding points in the game. (1) The protagonist crash-lands on an unknown planet, waking up in a deserted desert with no memory. (2) After discovering a locked house and a large tree nearby, he finds a sarcophagus with mysterious symbols and a notebook. Decoding the symbols using the notebook (n-back task), they open the sarcophagus and find a key. (3) Returning to the house, they unlock the door and explore, finding a compass, notes, and a toolbox (Go-No Go task). (4) Upstairs, they discover books, a brochure for another planet, and a map (Corsi block-tapping task). (5) Using the toolbox, the protagonist repairs the plane and, with the help of the compass, sets a course for a planet with people (Trail-making task). All in-game quests woven into the storytelling of the game are related to four frontal functions as shown in the figure above.